Distance to A&E linked to risk of dying

The further a seriously ill patient has to travel by ambulance
to reach a hospital's emergency department the more likely they are
to die, new research has found.

The study, carried out among more than 10,000 patients in the
UK, established that the risk of death for people who are
unconscious, not breathing or have chest pain rose by 1 per cent
for every 10km (6.2 miles) travelled.

The findings, just published in the Journal of Emergency
Medicine, come as no surprise to those fighting to save A&E
units in smaller hospitals across the State.

Researchers from the University of Sheffield looked at 10,315
seriously ill patients taken to hospital between 1997 and 2001.

They found that while 6 per cent of patients died overall, the
numbers rose with the distance to hospital.

Just 5.8 per cent of those who travelled up to 10km died, while
7.7 per cent of those who were taken between 11km (6.8 miles) and
20km (12.4 miles) did not survive. Among patients who travelled
21km (13 miles) or more, the mortality figure rose to 8.8 per
cent.

Consultant cardiologist at Portiuncula Hospital, Ballinasloe, Dr
John Barton, is a former chairman of the Hospital Services Action
Group (HSAG) set up in the wake of the publication of the Hanly
report which recommended A&E units at smaller hospitals be
replaced with nurse-led minor injury units. He said the new study
confirms earlier research which the HSAG highlighted to the
Department of Health.

"The findings of the UK study do not surprise me one little bit.
I get very deeply concerned about people at the very top in the
Health Service Executive (HSE) and Department of Health who believe
they need to centralise all acute emergency care services, for
example, in the northeast.

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They are apparently totally unaware of the research that shows
the dangers for patients in that sort of scenario and this worries
me intensely," he said.

Dr Barton said it was ludicrous to try and equate the level of
management and care that a heart attack patient would get in the
back of an ambulance with the care they would get in Portiuncula
Hospital or any other hospital.

"I myself have seen many patients over the years who would have
died if the ambulance they were travelling in had passed the front
door of Portiuncula and taken them straight to University College
Hospital Galway," he added.

Marie O'Connor, author of the recently published Emergency -
Irish Hospitals in Chaos and public relations officer for the HSAG,
said: "The whole issue of closing A&E units is a serious issue
for everybody, not just people living in non-urban areas. For
example, people living in Dublin go down the country for work, on
holidays and to visit family. There are 20 crashes on the country's
roads every day. If the Government proceeds with its plans to close
down A&E units, we will all be at risk."

Meanwhile, former senator Kathleen O'Meara of the Nenagh
Hospital Action Group said she was aware of a number of cases where
people would have died if Nenagh Hospital's A&E unit was not
there.

"Without the availability of the trauma unit and the range of
services at Nenagh Hospital, these people would have died, as has
happened in Monaghan. It's common sense that the further away a
person is from hospital, the higher their chances of dying, but
it's good to have it backed up by proper statistical analysis like
this new UK report," she said.

Hospitals threatened with closure of their A&E facilities
include Monaghan, Dundalk and Our Lady's Hospital, Navan, in the
northeast as well as hospitals in Ennis, Nenagh and St John's
voluntary hospital in Limerick. Meanwhile, the HSE West is
reviewing services at Portiuncula Hospital and Roscommon County
Hospital.